Early initiation of breastfeeding and associated factors among mothers with children &lt;2 years in Simiyu region, Tanzania

doi:10.21203/rs.3.rs-2236656/v1

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Early initiation of breastfeeding and associated factors among mothers with children <2 years in Simiyu region, Tanzania

https://doi.org/10.21203/rs.3.rs-2236656/v1

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Background

Breast milk provides infants with complete nutrition for immune development and protection against childhood diseases. Lack of breastfeeding increases the risk of infant and child morbidity and mortality. Early initiation of breastfeeding (EIBF) aids in the provision of colostrum to newborns, which provides protection against infection and improves newborn and infant survival.

Objective

To determine the prevalence of EIBF and associated factors among mothers with children < 2 years in the Simiyu region, Tanzania.

Methodology:

The study utilized data from a cross-sectional study conducted by AMREF Health Africa among women of reproductive age (15–49 years) in Simiyu region, Tanzania. An interviewer-administered questionnaire was used for data collection. The dependent variable was early breastfeeding initiation, measured by asking women on the time they started to breastfeed their child after birth. Stata 15 was used for data cleaning and analysis. Continuous variables were summarised using mean and standard deviation, while categorical variables using frequency and percentage. A multilevel logistic regression analysis was used to determine factors associated with EIBF.

Results

The mean age of 669 women analyzed was 28.29 years (SD = 6.8). The prevalence of EIBF was 62.2%, ranging from 52.7% in Bariadi district to 73.3% in Maswa district. Lower odds of EIBF were among women who had a caesarian section (OR = 0.41; 95% CI = 0.17–0.98) and those who gave birth to male children (OR = 0.57; 95%CI = 0.39–0.82). And higher odds of EIBF were among mothers who had their babies placed on their chest/abdomen (skin-to-skin-contact) (OR = 2.40; 95%CI = 1.53–3.83) and women from Maswa district (OR = 2.73; 95%CI = 1.09–6.89).

Conclusion

The prevalence of EIBF in Simiyu is slightly lower than the national target (65% by 2025) and good according to the WHO classification. Nonetheless, it’s low in comparison to the global target (70% by 2030). The practice of skin-to-skin contact between mother and child should be encouraged immediately after delivery. Education emphasising EIBF without child sex discrimination should be provided to women at antenatal care (ANC) and in the community at large.

Breastfeeding

Initiation of breastfeeding

optimal breastfeeding

early initiation of breastfeeding

Breast milk provides complete nutrition to infants, is essential for immune development, and protects against childhood diseases (1). Lack of optimal breastfeeding is associated with long-term impacts, such as poor productivity due to compromised intellectual growth (2). About 166 million and 9 million cases of diarrhoea and pneumonia in children under two years can be avoided by optimal breastfeeding practices., Sub-optimal breastfeeding is attributed to 595 379 child deaths each year of which 56% occur in Sub-Saharan Africa (3). Optimal breastfeeding practices start from birth, delayed initiation of breastfeeding increases the risk of neonatal mortality. Infants who are initiated to breastfeeding between 2–23 hours after birth have a 33% higher risk of death compared to those initiated to breastfeeding within one hour and the risk increases even more for those breastfed more than 24 hours after birth (4).

Globally, in 2017, only 42% of newborns were initiated breast milk within one hour of delivery (5). In sub-Saharan Africa (SSA), the prevalence of early initiation of breastfeeding (EIBF) was 58.3%, ranging from 24% in Chad to 86% in Burundi (6–9). In Tanzania, the prevalence of EIBF is 51% varying between 26% in the Simiyu region to 80% in the Tanga region (10). The national estimate and that of the Simiyu region are below the global targets of EIBF rates of 70% by 2030 (11). Further studies in Tanzania show a variation of EIBF practice ranging from 51% in Rufiji, Kilombero and Ulanga districts to 83.1% in Kilimanjaro Northern Tanzania (4, 12–15) Several factors are reported to either negatively or positively influence EIBF practices including community factors, maternal social-demographic factors, newborn factors, and reproductive and health services (16–18).

To facilitate breastfeeding practices in achieving the national EIBF target of 65% by 2025 (19), the government of Tanzania implemented several national strategies for infant and young child feeding and nutrition interventions (20). Despite these efforts, reports show that there is still a low prevalence of EIBF and the Simiyu region reported the lowest prevalence of 26% (10). Differences in health services coverage and population dynamics across the country make EIBF practices vary across regions. Although Simiyu had the lowest prevalence of EIBF in Tanzania, no study documented the factors that influence EIBF in this region. Given this context, it is vital to identify determinants of EIBF among mothers in different parts of the country, especially with a low prevalence of EIBF to help formulate appropriate interventions that help to minimize these variations. Hence, this study aims to determine the prevalence of EIBF and associated factors among mothers with children less than two years in the Simiyu Region lake zone in Tanzania.

Study design and setting

This cross-sectional study utilized data collected in the Simiyu region from May 20th to June 3rd, 2021 by Amref Health Africa in Tanzania. The population of the Simiyu region according to the 2021 projection is approximately 2,418,495 with a growth rate of 5.0,(21). Agriculture is the most dominant economic activity in the region. Other economic activities include fishing, trade and commerce. The region has reported excessively worse situations for maternal and child health services coverage like postnatal check-ups (10%), facility delivery (40%), and newborns who received postnatal check-ups within two days (15%). Moreover among children under five years, 33.3% and 5% are reported to be stunted and wasted, respectively, and only 15% of children were exclusively breastfed in the region (10).

Sample Size And Sampling

A multi-stage cluster sampling was used. In the first stage, Enumeration Areas (EAs) in the Simiyu region from the 2012 Tanzania population and housing census were used as the sampling frame. A random number of clusters to be included were selected, and a total of 51 clusters were randomly selected for inclusion out of 67 clusters. From sampled clusters, enumeration of all households and their residents was carried out by a team of enumerators and mappers from the National Bureau of Statistics (NBS) to draw up a list of all the households in each cluster. In stage two, the number of households to be included in each cluster was selected, yielding a total 2035 of households. All women and men aged 15–49 residing within the selected households, who consented were interviewed; a total of 2020 women were interviewed. This study includes women of reproductive age (15–49 years) who gave birth two years preceding the survey. Out of 2020 women, 754 women gave birth less than two years before the survey. Among them 72 resorted to never breastfeeding their children and 13 had missing information on EIBF. As a result, 669 women were analysed (Fig. 1).

Data Collection Methods And Tools

An interviewer-administered questionnaire used for data collection was developed based on questions from the Tanzania 2015/16 Demographic and Health Survey (DHS). The questionnaires were translated into Swahili and installed on an android tablet using Open Data Kit (ODK) for data collection. The questionnaire captured information on pregnancy, deliveries, post-delivery care, family planning, sexual activities/behaviours, and decision-making on various issues such as healthcare utilization and management of household income. Information on EIBF was captured in the questionnaire. Data collection was done by a team of twenty research assistants (RAs). The head of the household provided permission to interview all eligible women available in the household.

Study Variables

The dependent variable was EIBF. EIBF refers to the initiation of breast milk feeding within one hour after delivery (11, 13, 14, 22) and was classified as “1” if breastfeeding initiation was within one hour and “0” if otherwise.

Independent variables included maternal and child demographic characteristics and reproductive and maternal health services. Maternal demographic characteristics included maternal age (15–19, 20–24, 25–29 and 30 + years), education level (non-formal education, primary, secondary,), marital status (single, married, cohabiting, divorced/ widowed), maternal employment (employed, not employed) and district of residence (Bariadi, Itimila, Busega, Maswa, Meatu). Child characteristics include child’s sex (male, female). Reproductive and maternal health services included; number of antenatal visits (< 4, 4 visits and more), place of delivery (health facility, home/others), mode of delivery (vaginal, cesarean section), placing of the baby on mother’s chest/abdomen after delivery (skin to skin contact) (yes, no), level of health facility of delivery (health centre, dispensary, hospital), birth attendant (health professionals, traditional birth, and friend/relative/ others).

Data Management And Analysis

For data cleaning and analysis, STATA software version 15 was used. Continuous variables were summarized using mean and standard deviation, while categorical variables were summarized into frequencies and percentages. To compare the proportion of EIBF between groups of independent variables, a cross-tabulation of EIBF against each independent factor along with a Chi-squared test was done. Since the study used data collected by a cluster sampling technique, the observations are dependent at several hierarchical levels, thus using a classical logistic regression may not be appropriate in analysing this data (23). Therefore, a multilevel logistic regression analysis model was used. To determine whether multilevel regression was required for the data set, a null model (a model without exposure variables) was first fitted. The intra-class correlation (ICC) a measure of the degree of variability between clusters (24), indicates that there was a significant cluster difference.

Moreover, two models were fitted: model 1 was a two-level random effects model with clusters (enumeration areas) as level 2. Model 2 was a three-level model with households as level 2 and clusters (enumeration areas) as level 3. In model 2 the ICC indicated that there was no significant difference between the households. As a result, the log odds of EIBF were best modelled using model 1 a two-level logistic regression with the following equation.

$$log\left[\frac{{\pi }_{ij}}{1-{\pi }_{ij}}\right]= {[\beta }_{o}+{\mu }_{j}]+ \sum _{k=1}^{n}{\beta }_{k}{x}_{ikj}+ {e}_{ij}$$

Where; ${{\beta }}_{{k}}$ Are the fixed coefficients, ${{\beta }}_{{o}}$is the intercept-the odds of EIBF at the baseline levels of the explanatory variables, ${{\mu }}_{{j} }$is the random effect for the j^th cluster (enumeration areas, that is the effect of the enumeration areas on EIBF), ${{e}}_{{i}{j}}$is random errors at the individual levels, i and j are the level 1 (women of reproductive age (15–49 years) and level 2 clusters (enumeration areas) units, respectively, n is the number of explanatory variables and${{X}}_{{k}}$ is a set of explanatory variables both individual and community-level variables.

A bivariate analysis was performed to identify variables that are associated with EIBF. Variables with p-value < 0.10 analysis and those identified in the literature as potential confounders were considered for multivariable analysis. Akaike Information Criteria (AIC) together with the ROC analysis/curve were used for the final model selection. In multivariable analysis variables with a p-value of ≤ 0.05 were considered statistically significant.

EIBF proportion by participant background characteristics

A total of 669 women of reproductive age (15–49 years) were analysed, with a mean age of 28.29 years (SD ± 6.8). Of all women in this study, 184 (27.5%) were aged 20–24 years. The majority of them 526 (79.7%) were married, 458 (68.5%) had primary education, over half, 392 (58.6%) were employed, and 336 (50.3%) gave birth to a male child (Table 1).

The prevalence of EIBF was 62.2%. The prevalence of EIBF differed significantly by resident district, mother's age, and child's sex. Maswa district had the highest prevalence of EIBF 73.3% (95% CI = 66.5–79.1) and the lowest being in Bariadi district 52.7% (95% CI = 44.1–61.1). Among women aged 25–29 years 72.8% (95% CI = 65.7, 78.9) initiated breastfeeding within 1 hour. Furthermore, 67.5% (95% CI = 62.2–72.3) of female children were initiated to breastfeeding within 1 hour. (Table 1).

Table 1

EIBF by background characteristics of study participants (n = 669)
Variable	Total (%)	EIBF		p-value
Variable	Total (%)	Yes (%)	95% CI
Maternal Age				0.002
Mean (standard deviation)	28.29 (6.8)		27.8–28.8
15–19	45 (6.7)	25 (55.6)	40.8–69.4
20–24	184 (27.5)	108 (58.7)	51.4–65.6
25–29	173 (25.9)	126 (72.8)	65.7–78.9
30–34	133 (19.9)	88 (66.2)	57.7–73.7
35+	133 (19.9)	69 (51.9)	43.4–60.3
Education level				0.984
No formal education	125 (18.7)	77 (61.6)	52.7–69.7
Primary education	458 (68.5)	285 (62.2)	57.7–66.6
Secondary education	86 (12.7)	54 (62.8)	52.1–72.4
Marital status*				0.500
Single	75 (11.4)	46 (61.3)	49.8–71.7
Married	526 (79.7)	325 (61.8)	57.5–65.9
Cohabiting	59 (8.9)	41 (69.5)	56.5–79.9
Employment status				0.312
Employed	392 (58.6)	250 (63.8)	58.9–68.4
Not employed	227 (41.4)	166 (59.9)	54.0-65.6
District				< 0.001
Bariadi	156 (23.3)	79 (50.6)	42.8–58.4
Busega	98 (14.7)	65 (66.3)	56.4–75.0
Itimila	131 (19.6)	69 (52.7)	44.1–61.1
Maswa	191 (28.6)	140 (73.3)	66.5–79.1
Meatu	93 (13.9)	63 (67.7)	57.5–76.5
Sex of a child				0.006
Male	336 (50.3)	192 (57.1)	51.8–62.4
Female	332 (46.2)	224 (67.5)	62.2–72.3
Age of a child				0.179
Mean (standard deviation )	10.2 (6.9)		9.7–10.8
< 6 months	219 (32.7)	138 (63.0)	56.4–69.2
6–12 months	211(31.5)	126 (59.7)	52.9–66.1
13–17 months	138 (20.3)	94 (69.1)	60.8–76.3
18–23 months	103 (15.4)	58 (56.31)	46.6–65.6
*Frequency does not tally to 669 due to missing values

Eibf By Reproductive And Maternal Health Characteristics Of Study Participants

Among 669 women analysed, 426 (66.2%) attended 4 or more ANC visits during the last pregnancy, 546 (81.6%) of women were delivered by a health professional birth attendant, virginal delivery was reported among 637 (95.2%) women, placing of the baby on mother’s chest/abdomen after delivery was reported among 452 (97.8%) women. A total of 539 (80.6%) women delivered in the health facility, and for those who deliver at health facilities 378 (70%) women delivered in dispensaries, (Table 2).

EIBF prevalence differed significantly by place of delivery, with 64.4% (95% CI = 60.2, 68.3) of women who delivered at a health facility practised EIBF. EIBF was also reported to be 67.2% (95% CI = 65.3–73.8) among women whose babies were placed on their chest/abdomen after delivery. Furthermore, 62.7% (95%CI = 62.3–71.8) and 62% (95%CI = 50.4–69.2) of women delivered in the dispensary and hospitals initiated breastfeeding within 1 hour respectively (Table 2).

Table 2

EIBF by reproductive and maternal health characteristics of study participants (n = 669)
Variable	Total n (%)	EIBF		P-value
		Yes n (%)	95% CI
Number of ANC visits *				0.945
< 4	218 (33.9)	135 (61.9)	55.3–68.2
4+	426 (66.2)	265 (62.2)	57.5–66.7
Mode of delivery				0.145
Virginal	637 (95.2)	400 (62.8)	58.9–66.5
Cesarean	32 (4.8)	16 (50.0)	33.1–66.9
Place of delivery				0.017
Health facility	539 (80.6)	347 (64.4)	60.2–68.3
Home	130 (19.4)	69 (53.1)	44.4–61.5
Skin to skin contact *				< 0.001
No	251 (32.2)	100 (46.5)	39.9–53.2
Yes	452 (97.8)	315 (69.7)	65.3–73.8
Birth attendant				0.131
Health professional	546 (81.6)	348 (63.7)	59.6–67.7
Traditional birth attendant	25 (3.7)	16 (64.0)	43.5–80.4
Friend/relative	98 (14.7)	52 (53.1)	43.1–62.8
Type of health facility of delivery				0.077
Hospital	103 (19.11)	62 (60.2)	50.4–69.2
Health centre	58 (10.8)	31 (53.5)	40.5–65.9
Dispensary	378 (70.1)	254 (67.2)	62.3–71.8
*Frequency does not tally to 669 due to missing values

Factors Associated With Eibf

In the bivariate analysis, women who had a caesarian delivery had 59% less likelihood of EIBF than those who had a virgin delivery (COR = 0.41; 95%CI = 0.20–1.04). When compared to female children, women who had male children had 0.62 (95%CI = 0.45–0.92) times lower odds of EIBF. In addition, mothers who reported placing the baby on their chest/abdomen after delivery (skin-to-skin contact) had twice the odds of EIBF compared to their counterparts (COR = 2.40; 95%CI = 1.53–3.83). Furthermore, compared to the women from Bariadi district, women from Maswa district had 2.73 times higher odds of EIBF (COR = 2.73; 95%CI = 1.09–6.89) (Table 3)

Results from the multivariable model showed that women who had a caesarian delivery had 59% less changes in EIBF than those who had a virgin delivery (AOR = 0.41; 95% CI = 0.17–0.98). Women who had male children had 0.57 (95%CI = 0.39–0.82) times lower odds of EIBF when compared to female children. In addition, mothers who had their babies placed on their chest/abdomen after delivery had twice the odds of EIBF compared to their counterparts (AOR = 2.40; 95%CI = 1.53–3.83). Furthermore, compared to women from Bariadi district, women from Maswa district had 2.73 times higher odds of EIBF (AOR = 2.73; 95%CI = 1.09–6.89) (Table 3).

Table 3

Factors associated with EIBF
	Crude analysis			Multivariable analysis
Variable	COR(SE)	95% CI	P-value	AOR (SE)	95% CI	P-value
Maternal age
15–19	1			1
20–24	0.97 (0.38)	0.45–2.09	0.947	0.89 (0.35)	0.42–1.94	0.782
25–29	1.88 (0.75)	0.86–4.11	0.113	1.81 (0.72)	0.82–3.95	0.141
30–34	1.47 (0.60)	0.66–3.28	0.340	1.30 (0.53)	0.58–2.91	0.523
35+	0.78 (0.31)	0.36–1.71	0.534	0.72 (0.29)	0.33–1.59	0.416
Education level
No formal education	1
Primary education	0.97 (0.24)	0.60–1.57	0.907	-	-	-
Secondary education	1.02 (0.35)	0.53–1.98	0.942	-	-	-
Marital status
Single	1
Married	1.07 (0.31)	0.61–1.90	0.81	-	-	-
Cohabiting	1.44 (0.61)	0.63–3.28	0.38	-	-	-
Employment status
Employed	1
Not employed	0.97 (0.18)	0.68–1.41	0.91	-	-	-
District
Bariadi	1
Busega	2.10 (1.16)	0.71–6.19	0.181	1.78 (0.96)	0.61–5.12	0.290
Itimila	0.84 (0.40)	0.33–2.16	0.719	0.84 (0.40)	0.34–2.13	0.719
Maswa	2.73 (1.29)	1.09–6.89	0.033	2.67 (1.22)	1.09–6.51	0.031
Meatu	2.02 (1.20)	0.70–5.86	0.196	1.62 (0.86)	0.58–4.57	0.358
Sex of a child
Female	1
Male	0.64 (0.12)	0.45–0.92	0.015	0.57 (0.11)	0.39–0.82	0.003
Number of ANC visits
< 4	1
4+	0.93 (0.19)	0.63–1.38	0.729	-	-	-
Mode of delivery
Virginal	1
Cesarean	0.46 (0.19)	0.20–1.04	0.063	0.41 (0.18)	0.17–0.98	0.046
Place of delivery
Health facility	1
Home	0.73 (0.17)	0.46–1.16	0.176	0.93 (0.48)	0.33–2.56	0.886
Skin to skin contact
No	1
Yes	2.31 (0.47)	1.56–3.44	< 0.001	2.40 (0.57)	1.53–3.83	< 0.001
Birth attendant
Health professional	1			1
Traditional birth attendant	0.89 (0.43)	0.34–2.31	0.807	1.56 (1.03)	0.43–5.65	0.494
Friend/relative	0.72 (0.19)	0.42–1.21	0.216	1.30 (0.73)	0.44–3.89	0.636
Level of health facility
Hospital	1
Health centre	0.66 (0.28)	0.28–1.52	0.330	-	-	-
dispensary	1.20 (0.37)	0.66–2.20	0.551	-	-	-

The prevalence of EIBF of about 62% in this study is slightly lower than the national target of 65% by 2025(19). Moreover is higher than the national estimate (51%) and that from Simiyu 26% (10) and Morogoro regions (51%) (13). However, the prevalence is lower than what was observed in the northern part of the country, where it ranges from 70–83.1% (14, 15, 22). This can be explained by an increase in ANC attendance and health facility delivery from 40% in 2016 to 80.6% observed in the current study among women in the Simiyu region over time(10), ANC visits and health Facility delivery provides an opportunity for health professionals to inform and assist mothers in the process of achieving timely breastfeeding initiation, which has improved EIBF knowledge and practises (15). The prevalence reported in Chad (24%) and Nigeria (38%) (8, 18) were also lower. However, the observed prevalence differs slightly from that observed in Northeast Ethiopia (63.6%) (6) but is lower than those in Burundi (86%), Malawi (78%), and West Ethiopia (80%) (7, 9, 18). As a result, progress in EIBF can be promoted with good interaction and communication between mothers and healthcare providers.

Placing of the baby on the mother’s chest/abdomen after delivery (skin-to-skin contact) was significantly associated with higher EIBF chance. After birth, early mother-to-baby contact promotes a baby-to-mother relationship, which has numerous advantages. One of these advantages is the development of nutritional behaviour, in which newborns naturally gravitate toward the breast, resulting in the baby sucking on the mother's breasts. This ensures that breastfeeding begins as soon as the baby is born. This finding is consistent with previous research from low and middle-income countries (25), Zimbabwe (16), and southern Ethiopia (26). In the absence of complications for either the mother or the child during delivery, the practice of skin-to-skin contact between mother and child should be encouraged immediately after delivery.

This study found that EIBF women who had caesarean section deliveries had a lower chance of EIBF than those who had virginal deliveries. A possible explanation is that mothers who had caesarean section deliveries required extensive post-operative care. During this time, the child is under the care of a paediatrician while the mother recovers from conditions such as general anaesthesia effect, pain, and fatigue, This, in turn, delays the initiation of breastfeeding (8, 15, 18). This finding is consistent with what has been reported in Kilimanjaro and Morogoro (13, 15). Also across other settings in SSA (8, 9, 16, 18, 27).

Male children had lower odds of EIBF than female children. This gender disparity in EIBF may be explained by cultural issues regarding male children in some African cultures. For instance, colostrum feeding is not encouraged in some African societies for male children, and male children are more likely than female children to receive prelacteal feeding (28). However, given that the majority of women reported giving birth in a health facility, the influence of EIBF by cultural issues regarding male children may also indicate missed opportunities among healthcare providers to emphasise and assist women on EIBF. This finding was consistent with the findings of a study conducted among ECOWAS countries (29), Ethiopian (30), and among African and Latin American settings (18). To emphasise equal EIBF among all newborns, regardless of sex in Simiyu region. More effort among healthcare providers on assisting, educating and emphasising EIBF without child sex discrimination should be provided to women at antenatal care (ANC), during delivery and in the community at large.

Mothers from Maswa district had higher odds of EIBF compared to those from Bariadi district. Disparities in EIBF among districts within the same region may be due to regional differences in maternal and child health care coverage and services. Moreover, when compared to other districts, Maswa district had the highest proportion of women who are more educated (secondary education). In addition, secondary or higher education has an impact on increased awareness and knowledge of EIBF, resulting in higher EIBF practises among women in Maswa district. Geographic variations in EIBF prevalence have also been reported in other settings in Tanzania (10, 13, 21) and SSA (16, 29).

The strength of this stud is that; the study included all the districts in the Simiyu region, hence results can be generalised to all women of reproductive age (15–49 years) in the Simiyu region. However, the study might face several limitations. Because the study used secondary data, variables like parity, child weight, multiple births, and gestational age at delivery were not captured, but they have been linked to EIBF in other studies. (16, 18, 22, 29), hence the results may be affected by residual/ unmeasured confounding. Furthermore, EIBF was self-reported by mothers, hence the potential for recall bias since multiple events occur concurrently during delivery, whereby the exact time for breastfeeding initiation may be incorrectly reported, leading to an overestimation of the prevalence of EIBF.

The prevalence of EIBF in the Simiyu region is slightly lower than the national target of 65% by 2025, moreover, it is still low in comparison to the global target of 70% by 2030. Furthermore, the prevalence varies by district, with the lowest prevalence being in Bariadi. Skin-to-skin contact, caesarian delivery, and a child's sex mostly influence EIBF in the Simiyu region. Good interaction and communication practices between mothers and healthcare providers should be emphasized in educating women about the importance of EIBF. Moreover, the practice of skin-to-skin contact between mother and child should be encouraged immediately after delivery.

EIBF Early Initiation of Breastfeeding; KCMUCo Kilimanjaro Christian Medical University College; MoHCDGEC Ministry of Health, Community Development, Gender, Elderly and Children; SSASab Saharan Africa; TDHS Tanzania Demographic and Health Survey; NBS National Bureau of Statistics; UNICEF United Nations International Children’s Fund; WHO World Health Organization

Ethical approval and consent to participate

The ethical approval for the current study was obtained from the Kilimanjaro Christian Medical University College Research and Ethics Review Committee (KCMU-CRERC) with certificate number PG 17/2021. Permission to use the Uzazi Uzima project data was obtained from Amref Health Africa in Tanzania. The primary survey (Uzazi uzima II project) ensured that all methods were carried out in accordance with relevant guidelines and regulations. The Uzazi Uzima II project survey protocal was reviewed and approved by the Muhas Research Ethics Committee (REC) with the reference number MUHAS-REC-09-2021-840. During data collection, Informed consent was obtained from all study participants. For the minor participants 15-17 years, an informed consent was sought from parent or guardian followed by assent prior the interviews. Unique identification numbers were used to identify study participants to maintain anonymity of participant records.

Consent for publication

Not applicable

Acknowledgements

We thank the Uzazi Uzima Amref term for the designing of the project and data collection. We also thank the Monitoring and evaluation team at Amfer who assisted on data retrieval for this study.

Funding

The study was funded by the Government of Canada through Global Affairs Canada (GAC). The funding source had no influence on the study's design, data collection, analysis, findings interpretation, or manuscript development.

Authors’ contributions

LJS contributed to the study design, data analysis and drafted the manuscript, HLM assisted in data analysis and manuscript development, FNN, S.M, SEM and AF contributed to data collection, and manuscript review, IBM and RNM reviewed the analysis and edited the manuscript. All authors read, commented on, and approved the final manuscript

Competing interest

All authors declare that they have no competing interests.

Availability of data and materials

The dataset for the Uzazi Uzima project is available at Amref Health Africa in Tanzania. The data used in this study are publicly available in Mendeley Data at https://data.mendeley.com/datasets/dgc555rc9f/1.

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Early initiation of breastfeeding and associated factors among mothers with children <2 years in Simiyu region, Tanzania

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Background

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Study Variables

Data Management And Analysis

Results

EIBF proportion by participant background characteristics

Eibf By Reproductive And Maternal Health Characteristics Of Study Participants

Factors Associated With Eibf

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